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At the end of her development cooperation career, Ruth Hildebrandt makes a case for ‘the German approach’

Ruth Hildebrandt in interview

‘I have always valued that the German approach to development cooperation allows us to do two things simultaneously’, says Ruth Hildebrandt. ‘To try and pull the right levers at a systems level, and to support real people - our partners - in their personal and professional development.’ In May 2019, we met to reflect on the challenges and highlights that shaped her career.

A gynaecologist and obstetrician by training, Hildebrandt describes her move into development cooperation as a “midlife decision”: ‘I had a senior post in a renowned university hospital in Berlin and could have continued to work there for the next twenty years. But something within me wanted a change of course.’ She never regretted the change.

From Berlin to Tanzania, Nigeria, Yemen, Pakistan, Eschborn and Malawi

Hildebrandt’s first posting for German development cooperation was with the Evangelische Entwicklungsdienst (EED) at the Kilimanjaro Christian Medical Centre, a university hospital in Tanzania, where her responsibilities – apart from clinical work – were academic teaching and strengthening junior doctors’ specialist training. A systems thinker right from the start, she decided to let the young doctors teach medical students in the specialist fields they were aspiring to, thus helping them to expand their knowledge while at the same time ensuring good teaching for the medical students.

Following a 2-year posting to a Nigerian health project and a year in London to complete her Masters in public health, Hildebrandt went as an integrated CIM expert to a GIZ-implemented health programme in Yemen. Once again taking a systems perspective, she successfully encouraged midwives to do outreach work and visit women at their homes, instead of waiting for them at the health posts which their husbands would rarely let them visit – often not even for deliveries.

What she remembers most fondly of her time as technical advisor and later head of a GIZ health programme in Pakistan is how they managed to get partners ‘burning’ for the issue of quality management and the particular quality improvement approaches that German technical cooperation introduced them to.

One year as a planner and backstopper at GIZ head office gave her a good overview not just of the challenges and achievements of German technical cooperation in health but also of the specter of tools and approaches in use by the different programmes and what kind of results they achieved. While all these experiences were rich and inspiring, it was her final post in Malawi that came closest to Hildebrandt’s vision of effective development cooperation.

Implementing comprehensive health systems strengthening

‘In Malawi, our programme strategy allowed us to support health system strengthening from all angles, and our outputs were formulated to express our focus on partner needs’ explains Hildebrandt. ‘We’ve been supporting quality management, health information systems, health financing, hospital autonomy and human resources for health – always focusing on the one goal: a strong health system for quality services.’ Covering four districts, including the capital Lilongwe with its central hospital, the GIZ programme has, under her leadership, aimed at ensuring that the whole pyramid of service delivery - from health centre to tertiary level - operates in an integrated manner, addressing health needs as effectively and as close to home as possible. ‘Through this integrated approach we wanted to make sure that patients stop travelling to Lilongwe’s central hospital for minor conditions that could and should be dealt with in their home district.’ Gradually, as service quality and management in district hospitals have started to improve, this envisioned service delivery pyramid is beginning to work.

Allow for chaos so that new ideas can emerge

Asked what her different posts taught her about effective programme management, Hildebrandt noted that she would encourage younger colleagues to have more confidence in their gut feelings. Particularly in new situations there is merit, as Hildebrandt puts it, to first ‘give room to chaos’ rather than coming in with a fixed plan. ‘Whenever I found myself in a new project context, I would take time to observe everything that was going on, allowing for chaos so that new ideas could take shape, from our partners and team members,’ she explains. ‘And then, when something concrete and promising emerged that seemed right and worth supporting, it was my responsibility as head of programme to make sure this could be supported in an expedient manner.’ The results her programme attained in recent years, and the relationships she has built with partners, both show that this programme management style has worked.

A case for the German approach to technical development cooperation

Comparing the German approach to technical development cooperation to that of other development partners, Hildebrandt lists three qualities that, according to feedback she’s had from partners, make the German contribution unique. First, they know that their German counterparts mean what they say – which makes them both transparent and reliable. Second, they know that Germans tend to favour and are able to provide technically sound and sensible solutions over flashy innovations. And third, they know that Germans will stay long enough to help develop and transform systems in a sustainable manner. It is this long-term commitment which Hildebrandt regards as essential: ‘One needs to be there long enough to build the trust that is needed so that partners can actually say what kind of support they really need and want and in which area – this isn’t something they will share in official government negotiations.’ It also allows German-supported programmes to actually work at the partners’ pace – a crucial condition for sustainable change.

A woman of many talents

At the threshold of retirement, Hildebrandt appears happy and relaxed. The transition from occupying a highly demanding programme leader position to being responsible only for herself seems to be going smoothly. Those who worked with her know that she is not just a medical expert, but also a passionate piano and harpsichord player who founded or joined music ensembles and organised concerts wherever she has lived. Having more time for her music and for reading are two of the pastimes she now looks forward to and the list of things she wants to do within the next few months is long. A woman of many talents, Ruth Hildebrandt will continue to inspire others. We wish her all the best for the years ahead!

Anna von Roenne
May 2019

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